CT腰椎间盘造影术对椎间盘源性下腰痛的诊断价值

The diagnosis of discogenic low back pain with CT discography

目的探讨CT腰椎间盘造影术对椎间盘源性下腰痛的诊断价值。方法对CT和/或MRI检查无腰椎间盘突出征象的25例慢性下腰痛患者34个腰椎间盘行CT椎间盘造影术,采用统一的椎间盘造影方法和1～5型CT椎间盘造影分型,分析阳性、阴性椎间盘注射对比剂的量。结果CT椎间盘造影的34个腰椎间盘中14个为2型,均为阳性椎间盘,注射对比剂量为0.2～1.1ml,平均0.65ml;2个为5型,均为阳性椎间盘,注射对比剂量0.8～1.1ml,平均0.95ml;11个为3型,其中3个为阳性椎间盘,注射对比剂量为0.7～0.9ml,平均0.8ml,8个为阴性椎间盘,注射对比剂量为1.2～1.7ml,平均1.45ml;7个为1型,即正常椎间盘和阴性椎间盘,注射对比剂量为1.2～1.8ml,平均1.5ml。阳性椎间盘([0.810±0.469)ml]与阴性椎间盘([1.480±0.364)ml]所注射的对比剂量的差异有统计学意义(P<0.01)。结论CT腰椎间盘造影术通过显示阳性椎间盘对盘源性下腰痛具有定性诊断价值,与普通腰椎间盘造影术比较,CT腰椎间盘造影术具有定位、诊断精确,操作时间短,患者痛苦少等优点。

Objective To evaluate CT discography（CTD） in diagnosis of discogenic low back pain. Methods CTD was performed in 34 discs of 25 patients, who had chronic low back pain but no disc herniation on the CT or MRI. Results CTD showed type 2 for 14 discs, type 3 for 3 discs and type 5 for 2 discs, and 7 was type 1 （normal or negative discs） . The positive discs were injected with 0.2~1.1ml （mean 0.65 ml） of contrast agent; while the negative discs were injected with 1.2~1.8ml （mean 1.5 ml） of contrast agent. The difference in the volume of contrast agent from positive（0.810±0.469）ml and negative（1.480±0.364）ml discs was statistically significant（P〈0.01）. Conclusion CTD can show the direct sign of disc disruption. The low back pain was related to the positive discs showed by CTD.